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REVUE DE L INFIRMIERE. 1991 May 21; 41(10):27-32.The coordinator and nurse of the anti-AIDS program of the Red Cross in Tanzania relates that families affected by the disease are helped with food, clothes, and moral support. The new illness appeared in 1983 in a zone at the Tanzanian-Ugandan frontier. The first victim of AIDS was a Ugandan merchant, and the infection spread to the large cities of the country mostly by heterosexual transmission facilitated by the prevalent practice of having multiple sexual partners. According to January 1991 WHO figures there were 7128 cases reported in the country among 24 million inhabitants, but this figure ought to be multiplied by 2 or more. 30% of women were found seropositive at Kigali in the north and 20% in Dar-es-Salaam. Certain informal sources project 64,000 AIDS cases for 1992. If the WHO estimation that 50-100 seropositive persons hide behind 1 patient with AIDS is correct, one could calculate 3.2-6.4 million of seropositive people for 1992. Officially, this is not admitted because of the hesitation to tarnish the image of the country trying to attract tourists. The Muhimbili Hospital in Dar-es-Salaam has 45 beds, but it can accommodate 60 patients on mattresses. Hospitalization is mostly for opportunistic infections, and often for tuberculosis. AZT is very expensive, even in countries where it is available. The association WAMATA, in existence since 1989, offers help to seropositive people or AIDS victims trying to stress prevention and educate people about the use of the condom, although the modification of people's behavior in a culture where sexuality and fertility are closely linked is difficult. The government budget is not sufficient for buying condoms for protecting the whole population. The National AIDS Control Program has the objective of sensitization of young people by sex education and by belatedly discouraging traditional wedding ceremonies where guests get drunk and engage in love-making.
REVUE DE L INFIRMIERE. 1991 May 21; 41(10):33-5.The coordinator of a project fighting against AIDS in Tanzania in collaboration with the government is a Danish nurse, one of 4 mobilized teachers, working for the Tanzanian Red Cross to spread the message of prevention in primary and secondary classes in the North of the Kagera region using original pedagogical methods such as theater, song, and poems. The educational project consists of a group of 8 persons (social workers and nurses) travelling in 2 groups directed by a doctor. The Red Cross helps orphans, providing them with uniforms and school supplies by turning to the village administration, who indicates which families need help with their health. At present the problem of the cholera epidemic is the most pressing, and AIDS is dealt with in conjunction with the filtration of water and the plantation of trees in the Red Cross program that started in March 1989. The extreme poverty is attributable both to AIDS and to the war with Uganda, in addition to economic difficulties caused by the free fall of the price of coffee, the principal cash crop of the region, and the fact that banana trees contracted a disease. It is a higher priority for most men to obtain food than a box of condoms, especially since the disease is hard to comprehend until symptoms appear. However, they do not distribute condoms, but only inform young people where to get them, partly because of the opposition of religious organizations to this preventive measure. The other solution is to have only 1 sexual partner, but a good number in their audience are Muslim who have several wives. Many other nongovernmental organizations mobilize in Tanzania with actions against this epidemic. Some people change their behavior, other never do, and the hope lies in making young people aware of this disease.
LINKS. HEALTH AND DEVELOPMENT REPORT. 1991 Fall; 8(3):11-2.The authors respond to Tony Dajer's critique of their study concerning the trend in Nicaraguan infant mortality and its possible explanations. It is pointed out that the sharp decline in Nicaragua's infant mortality in the mid-1970s is an intriguing phenomenon, since it began to occur at a time of economic slump, civil disturbance, and under a government that gave low priority to the social sector. It is contended that a number of factors (among them the Managua earthquake) prompted the government to shift its allocation of resources from hospital-based health care in the capital city to ambulatory health care throughout the country. After the revolution, the Sandinista government continued this process. Dajer's characterization of USAID-funded clinics as "notoriously ineffective" is rejected; arguing that although operating under overt political guidelines, these projects are well-advised by experts. Dajer's question as to the importance of health care within the Sandinista government is considered. It is maintained that the revolution was not fought in order to reduce infant mortality, and that health was not the primary concern of the Government of National Reconstruction. It was the international solidarity movement, not the Sandinista government, which focused so intently on infant mortality, hoping to find good news to report. The issue of health care had the added advantage of being politically noncontroversial. It is also maintained that since the mid-70s, the country's health policy has remained stable, despite the radical changes in government because the international arena helps determine national health policy.
INTERNATIONAL NURSING REVIEW. 1991 Mar-Apr; 38(2):31.A brief report summarizes issues and concepts discussed by participants from Malawi, Tanzania, and Zambia at the 2nd ICN/WHO intercountry conference in Lusaka, Zambia. Broadly discussing nursing care of people with HIV/AIDS and their families, counseling and case/family support should be considered major components of local initiatives in Africa. While local constraints must be recognized in diagnosing, counseling, caring for, and supporting cases and families, programs may also build upon community strengths. Present official health services are often unable to accommodate the needs of all patients with HIV/AIDS. Participants therefore examined innovative, new home-based approaches to care and case/family support. Examples of community-based support programs tailored to meet local needs are mentioned. The role of counseling in both case/family support and for behavioral change is also voiced. A multidisciplinary approach carried out by open, flexible, and understanding personnel is required. Nurses must provide clinical care to cases while also working to facilitate behavioral change.
Arlington, Virginia, Management Sciences for Health, Technologies for Primary Health Care [PRITECH], 1991.  p. (USAID Contract No. DPE-5969-Z-00-7064-00)Representatives from several nongovernmental organizations visited Uganda in February-March 1991 to help the Control of Diarrheal Disease (CCD) program bolster its ability to advance case management, training, and supervision of health care professionals. Specifically, the team focussed its activities on determining a strategy to create a national level diarrhea training unit (DTU) centered around case management for medical officers, interns and residents, medical students, and nurses. Similarly, it participated in developing a strategy for training traditional healers in diarrhea case management and for inservice training for health inspectors (preventive health workers). The team presented a generic model for a training/support system to the DTU faculty and CDD program manager. The model centered on what needs to be done to ensure that the local clinic health worker manages diarrhea cases properly and instructs mothers effectively to manage diarrhea. Further, in addition to comprehensive case management, content included interpersonal communication at all levels supplemented by supervision and training skills. It encouraged a participatory approach for training. In addition, it strongly encouraged the DTU faculty and CDD program staff to follow up on training activities such as supporting trainees and reinforcing skills learned in the training course. The team met with relevant government, university, and donor representatives to learn more about existing or proposed CDD activities. Further, the CDD program asked team members to assist informally in the surveyor training session for the WHO/CDD Health Facilities Survey. The team also spoke to WHO/CDD staff about its plans and future activities. WHO/CDD was concerned that training in interpersonal skills not weaken the quality of training in diarrhea case management.